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Help with Hard Questions Series
The increased rates of both diagnosis and pharmacological treatment for ADHD and other psychiatric illnesses in children have led to intense debates about whether those increases are appropriate. These debates can present dilemmas for families.
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People who are seriously ill often face decisions not only about medical treatment, but how they will manage medical treatment. One of the first decisions they face is how and with whom they want to share information about their health and health care.
More and more children in the United States receive psychiatric diagnoses and psychotropic medications—this is not news. With those increased rates of diagnosis and pharmacological treatment come sometimes intense debates about whether those increases are appropriate, or whether healthy children are being mislabeled as sick and inappropriately given medications to alter their moods and behaviors. Some of these debates are inevitable, given the conceptual issues surrounding the diagnosis and treatment of psychiatric disorders in general and the application of these diagnostic categories and treatment modalities to children in particular. In this report, we will describe many of those complexities, paying close attention to the ineradicable role that value commitments play not only in decisions about the appropriate modes of treatment, but also in diagnosis.
Evidence shows that changes in the architecture, design, and décor of health care facilities can improve patient care and in the long run reduce expenses. These essays detail the state of research, look inside two hospitals that put some of these innovations into practice, and consider how design fits into the moral mission of health care.
Personalized medicine—the customization of medical treatment to an individual's genetic profile—aims to both improve outcomes and control costs. But recent news, including scandals involving direct-to-consumer genetic tests and questions about targeted cancer therapies, has exposed many ethical hurdles.
A new personalized medicine essay set drawn from the September-October 2010 issue of the Hastings Center Report explores the tension between private ethical commitments and public policy in essays by ethicists, a patient, a medical student, and a consumer advocate.
From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns contains 36 overviews of issues in bioethics of high public interest, such as abortion, health care reform, human and sports enhancement, organ transplantation, personalized medicine, medical error, and stem cells. The chapters, written by leading ethicists, are nonpartisan, presenting reasonable considerations from various perspectives that are grounded in good scientific and ethical facts. They each include recent news stories, clickable experts to contact, linked resources, and (where available) recent legislation and campaign positions. Greater detail on how to use the book is in the introduction. The three framing essays offer valuable insights into the historical and increasing relevance of bioethics to public policy.
November 2007
This report examines the debates over patenting biomedical research and treatments, focusing on how those debates play out in the patenting of inventions involving genes and stem cells and the patenting of drugs for HIV/AIDS. It concludes with a comprehensive review of laws, policies, and practices that aim to preserve or create incentives for innovation in biomedicine, promote further research, and provide access to treatments.
This report from The Hastings Center explores the ethical dimensions of efforts to make health care safer and better through continuous improvements in patient care, with special attention to the relationship between everyday QI activities and the ethical rules and regulations governing human subjects research. It offers practical recommendations for ensuring that QI meets ethical requirements, proposes a cooperative effort by public and private entities to develop clearer guidance on the relationship between ethical oversight of QI and human subjects research regulations, and makes other policy recommendations aimed at promoting safety and quality in health care through the ethical conduct of QI.
This report contains 10 essays that present a synoptic overview of the most important developments in end-of-life decisionmaking and take stock of their successes or failures. The essays also provide ideas for a new strategy to improve care for the dying, and examples of ways to reevaluate and improve advance directives and surrogate decisionmaking.
This four-part report aims to help readers understand what geneticists believe they have discovered about how genetic differences are related to observed, or "phenotypic," differences. It also helps readers contemplate what those findings might mean for how we think about who we are.
In 2000, the Institute of Medicine reported that as many as 98,000 Americans die each year as the result of medical error. This special report on patient safety seeks to foster clearer and better informed discussion of the ethical concerns that are integral to the development and implementation of effective policies that would address the problem of medical error.
This report discusses how new techniques at the intersection of reproductive medicine and genetics raise complex ethical questions that should not be resolved by a largely unregulated market. Rather, they demand policies that have been publicly and transparently developed.
This report looks at issues of social justice, access, and public policy in hospice and palliative care. As it examines the issues from the perspectives of social justice and fairness, it also recommends ways in which the definition of hospice can be expanded to include more Americans for a longer period of time than simply the days or months shortly before death.
Serving on a hospital's board of trustees requires confronting a variety of difficult ethical problems that are almost never discussed and rarely recognized even by trustees themselves. This supplement presents trustees' own views of their work and develops a framework for doing that work well.
This supplement presents a cross-cultural dialogue about the fundamental professional values of medicine that shape medical practice, teaching, and research in China and the United States. Articles by Chinese and American scholars who participated in a four-day conference in Beijing in 1998 explore the ethical traditions of these two very different cultures. While the history of the two countries differs significantly, these essays reveal that physicians in the United States and China share many core ethical values that define and order their professional lives.
Prenatal screening for "disabling" genetic traits seems self-evidently good to some people. But the disability rights movement has criticized such testing as morally problematic and driven by misinformation about what it is like to live with a disability. This supplement, the report of a two-year project at The Hastings Center, explores concerns about the hurtful message that testing may send, the problematic attitudes toward children that prenatal testing can foster, and the way such testing can allow an evaluation of traits to stand in for an evaluation of persons. It offers recommendations regarding genetic counseling and educating people about disabilities to help inform public conversation about what genetic tests we might permit and which we should not employ.
An increasing number of biotechnologies offer ways of "enhancing" people. Examples are cosmetic surgery, gene therapies, performance drugs, and psychopharmacological agents such as antidepressants. This supplement tries to clear the conceptual ground for assessing such enhancements. It considers a range of possible moral concerns and from these draws several lessons for public policy.
A working group assembled by The Hastings Center explores the structure of health care delivery in managed care, ponders its potential effect on patient care, and queries the market orientation of managed care. It notes problems with the current structure and shows how these problems necessitate further study of organizational and systemic issues in health care delivery.
Early in the AIDS epidemic, The Hastings Center recognized that AIDS would present not only familiar ethical dilemmas in the form of decisions about death but, perhaps more important, novel ones. Most people had come to believe that infectious diseases in the late twentieth century either were confined to undeveloped countries or could be readily controlled by the modern pharmaceutical armamentarium. The AIDS epidemic challenged this belief. How would society approach the threat of a mysterious and ultimately fatal transmissible disease in an era when individual liberties and the rights of minorities had been given new emphasis in law and ethics? This special supplement investigates the kind of public health response necessary.
The articles in this special supplement offer commentary from a variety of perspectives on the AIDS problem as it was understood in the mid-1980s. Social structure and disease have always interacted closely, but rarely has this interaction been as complex or as challenging as during the first years of the AIDS outbreak. To understand the social and ethical issues—the main theme here—the basic scientific and medical facts are summarized, serving as background for analysis of the policy problems. This publication made an important contribution to the public discussion that was taking place at the time.
This special supplement looks at the duties of—and risks to—treating physicians in the face of AIDS and HIV infection. Prior to the outbreak of AIDS, health care workers in America and other advanced industrial societies had all but forgotten the formerly routine risk to physicians of contracting lethal diseases from their patients. The possibility of HIV transmission in health care settings forced physicians and other health care workers to once again confront this unpleasant reality. The articles in this supplement offer guidance on how they should respond.
This special supplement emphasizes the points of consensus that participants in the Ethics of Animal Experimentation and Research project reached: that the use of animals in science involving animal suffering or harm is decidedly an ethical issue; that the greater the ethical cost is to the animals, the more compelling is the justification required; and that at some point we perhaps move beyond the limits of ethical justification in our treatment of animals for human ends.
This special supplement examines a number of bioethical issues—particularly those surrounding reproductive technologies—from within the context of several countries around the world, paying special attention to how the debate surrounding these issues is affected by unique cultures, political regimes, and religions. It offers a fascinating instance of the interplay of identity and diversity—different answers to identical problems, and similar concerns expressed in the differing answers.
This special supplement features short essays that look both forward and back written by several of the participants in The Birth of Bioethics conference, held at the University of Washington, Seattle, to mark the thirtieth anniversary of the publication of the pioneering Life magazine article, “They Decide Who Lives, Who Dies” (November 9, 1962). “Whether the Seattle events were a birth, a conception, or merely a gleam in someone’s eye,” Albert Jonsen writes, “I thought it a good time for early workers in the field to gather, reminisce, and perhaps, begin to make a history.”
This special supplement is the culmination of The Hastings Center’s research project, The Ethics of Animal Biotechnology, which grew out of a prior project, Ethical Issues in Animal Experimentation and Research (see “Animals, Science, and Ethics,” May-June 1990). It takes a close look at the ethical implications of biotechnological intervention into animal life. These new technologies have the potential to alter nature radically. But are our manipulations ethically legitimate? Do we have the moral right to undertake them? And if so, under what conditions and within what limits?
In this essay set, 11 authors each examine a foundational value and its implications for health policy in the United States. In the introduction, Hastings Center president Thomas H. Murray writes: "Core American values, rather than existing in ineluctable tension with one another, form a sturdy, mutually reinforcing foundation for health reform. Universal participation may be a concept whose time has finally come." Authors include leaders in bioethics and health policy.
The moral issues confronting the field of rehabilitation medicine range from issues familiar at the clinical level (like informed consent and paternalism) to those familiar at the societal level (like allocation of scarce resources). Yet if these issues were in one way familiar, their context is different from acute care medicine—often strikingly so. Rehabilitation therapy is a long process, allowing much time for moral struggles to play out. There is a great need for active patient participation in treatment, and often many medical professionals and family members are involved as well, adding to the medical and ethical mix. This special supplement—a product of The Hastings Center project, Ethical Issues in Rehabilitation Medicine—analyzes the elusive and complex issues that can result. A separate volume of case studies in this area (“Case Studies in Ethics and Medical Rehabilitation”), also a product of this project, is available as well.
A specter haunts the American health care system—the prospect of widespread chronic illness and disability in an aging society. With it comes a daunting challenge to our health care delivery system, social welfare services, families, and communities, as well as to us as individuals. This special supplement grew out of the work of the Ethics and Chronic Illness project and attempts to outline the main points of the new agenda for bioethics that chronic illness demands.
This collection of case studies is meant to provide concrete case material for educational or study purposes on ethical problems in the field of medical rehabilitation. These problems range from those focused on patient care and patient rights—for example, issues of freedom, autonomy, truth-telling, and confidentiality—to those that center on larger societal issues—for example, questions regarding selection of patients and fair allocation of resources. It is—along with an August 1987 special supplement, “Ethical and Policy Issues in Rehabilitation Medicine”—a product of The Hastings Center project, Ethical Issues in Rehabilitation Medicine.
In the 1980s, home care was one of the fastest growing sectors in our health care system. For the frail elderly in particular, home care agencies became a major source of medical, nursing, and social services. This special supplement offers an initial exploration of home care and its distinctive ethical problems, particularly in the areas of autonomy and allocation, and specifically with regard to the frail elderly. It grew primarily out of a collaborative research project of The Hastings Center and the Division of Legal and Ethical Issues in Health Care at Montefiore Medical Center on the autonomy of the elderly in long-term care, but also includes additional material from an earlier Hastings Center project that compared home care of the elderly with community-based care of the mentally ill and took a preliminary look at many of the ethical issues crucial to this report.
This special supplement grew from The Hastings Center project, The Genetic Prism: Understanding Human Health and Responsibility. Participants stressed the active role researchers play in shaping knowledge, planting the seeds of the answers they will arrive at in the way they frame their questions. Much hangs on the language we invoke as we map the human genome. Words like defects, flaws, disorders, and abnormal can foster stigmatization and discrimination. The practical ramifications of the socially constructed language of disease are most evident in the clinic and the workplace. The diagnostic and predictive potential of genetic knowledge has created problems in these settings that must be explored. The articles gathered in this supplement attempt to do so.
In 1983 a grassroots citizen education group in Oregon began a series of public meetings to discuss the social and personal choices imposed by the new powers of modern medicine and the rising costs of the health care system. This was the beginning of Oregon Health Decisions, an organization aiming to make health care delivery more congruent with community values. With benefit of hindsight, one can see that a new dimension was about to emerge in health planning and policy-making in the United States. An element of broader civic participation was about to join the ongoing quest for some measure of social consensus on the basic goals and priorities of the health care system. This report examines the positive role citizen participation can play in shaping health care and health policy.
Since the 1973 Supreme Court decision legalizing abortion, medical and scientific developments focused greater public and professional attention on the status of the fetus. The cumulative effect of this influenced legal, social, and moral thought and set the stage for challenges to legalized abortion. There was not then (nor is there now) an inexorable convergence of medical data and legal opinion capable of undermining the rationale of Roe v. Wade. But the prochoice movement should find room for an open airing of the moral questions if abortion is to remain a legally acceptable act. This short supplement examines these moral questions; it grew out of a Hastings Center project, Abortion and Scientific Change Since Roe v. Wade.
In the late 1980s and early 1990s, medicine offered American women a new generation of safe, reversible, and highly effective long-acting contraceptives. Increased birth control options would seem a good thing; however, the social reception of these new methods—particularly the widely publicized Norplant—was mired in controversy. Instead of being seen as one means for enhancing reproductive choice, long-term methods were viewed as limiting personal control and even as possible instruments of gender or racial discrimination. The participants of a Hastings Center project on the ethics of long-acting contraception believed that unnecessary conflict and confusion about these methods arose because they were seen as emblematic of coercion in the face of personal liberty—a way of looking at them that blinds us to relational realities. In this report, they outline an alternative perspective developed during the two-year project that takes fuller account of the social dimension of reproduction and contraceptive decision-making, providing guidelines for policy-makers and health care providers.
While controversy over euthanasia is hardly new, developments in medical technology that enable almost indefinite prolongation of life (though often accompanied by intense pain and suffering) have prompted a reconsideration of basic moral norms in an era that champions an ethic of patient autonomy. Western moral traditions have consistently affirmed the value of life as an inherent—but not an absolute—good; and once the door is open to qualitative assessments of life, the question is whether any moral line against beneficent killing can be drawn, and who should draw it. This special supplement has been developed to help the reader think through the professional, philosophical, theological, legal, and policy issues posed by euthanasia.
Both mental health patients and providers have good reason to be concerned about health care reform. Historically, mental health services have not received the same support as physical health. This report, a product of The Hastings Center project, Priorities in Mental Health, explores the issues central to setting priorities in mental health. It surveys the purported reasons both for and against doing so, identifies de facto priorities in the history of mental health policy in the United States, appraises the ethical criteria proposed to evaluate priority plans, and identifies the present state of affairs in priority setting, along with what mental health policy has to gain from discussions of this kind.
This is the first special supplement published under The Hastings Center’s Humans and Nature Program, which explored long-term moral responsibilities to the human and natural future. Participants particularly wanted to examine regional issues from an ethical perspective, trying to consider together the many values and moral obligations pertaining to humans and nature, and to take nature seriously as a moral and civic regional concern. Nature, Polis, Ethics takes as its subject the pressing issue of the Chicago region’s future development, including the protection of open lands and historical natural and cultural landscapes, in the face of regional fragmentation, dislocation, and development pressures.
Nursing homes are not lacking in regulation, guidance, or advice from the outside, nor are the ethical responsibilities of health care providers and families completely undelineated in a nursing home context. But regulation and social policy are often inconsistent and sometimes make good care harder to provide, in part because we have not developed as a society a moral vision and a set of aspirations for what we want nursing homes to be. Complicating this problem is the fact that ethical issues in long-term and nursing home care are usually considered from a bioethics framework designed for issues in hospital-based and acute care. This report explores how notions based on acute care—particularly individualistic conceptions of autonomy and interests—can be modified so that they resonate more fully with the predicaments of nursing home residents, caregivers, and family members. It also aims to place these issues more securely on the research agenda for the field of bioethics.
This supplement—prepared in conjunction with The Hastings Center’s project, Making Advance Directives Work: Implementing the Patient Self-Determination Act—is a collection of essays examining the practicalities of putting the PSDA, which went into effect on December 1, 1991, into action. The act was intended to empower people to take part in decisions that affect the duration and condition of their lives. It requires that all individuals receiving medical care be given written information about their rights under state law to make decisions about their care, including the right to accept or refuse treatments and the right to formulate advance directives. It applies to all health care institutions (hospitals, nursing facilities, hospices, home care programs, and HMOs) receiving Medicare or Medicaid. The essays address the PSDA’s requirements and possible ramifications to patients, families, different medical institutions, and society as a whole.
In the 1960s and 1970s the tenor of discourse on professional ethics changed drastically, amid a growing concern with the rights of clients and a backlash against professional paternalism. Each of the professions underwent a process of intellectual ferment, social transformation, and ethical redefinition. The resulting new “social contract” between society and the professions requires that the professions take their duty to serve the public interest and the common good much more seriously than ever before. The short essays in this supplement provide a framework for discussing public roles and duties applicable both to the professions as a whole and specifically to the six fields studied in The Hastings Center project, Professional Ethics and the Public Role of the Professions: medicine, law, social work, journalism, corporate management, and public administration.
In Priorities in the Clinical Application of Human Genome Research—The Hastings Center project that informed this special supplement—participants returned to two topics of perennial interest: genetics and allocation of health care resources. The potential number of diagnostic tests and therapies emerging from advances in genetics, along with the multitude of unresolved ethical issues they brought with them, provided fertile ground for analysis. If society is to decide which genetic technologies to make widely available, then which technologies are more important, and which are less so? On what basis should priorities be set? And who in particular should set them? This supplement provides an overview of the topics that must be considered if resources are to be allocated in thoughtful and ethically defensible ways.
In the spring of 1980, the U.S. Senate Select Committee on Ethics, under a mandate to conduct a thorough examination of its then-current Code of Official Conduct and present recommendations for change to the Senate, asked The Hastings Center for assistance in its efforts. The purpose of this special supplement is to describe some of the issues faced by the Select Committee in attempting to make recommendations on revisions, to analyze the problems posed by efforts to revise the Senate code, and to present The Hastings Center’s proposed model code.
When the proposal was first broached in 1987, controversy engulfed Oregon’s plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment. Response nationwide was immediate and sustained, with proponents and critics hotly debating the virtues and vices of the proposed scheme for allocating scarce health care resources. As part of the ongoing debate, The Hastings Center cosponsored (with the Wesley Foundation) a two-day conference in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform. The two articles in this conference report explore the insights resulting from this meeting.
At the time this report was written, economic, social, and scientific pressures were forcing policy-makers throughout the world to attempt medical and health care reform. But the participants of this project believed that these efforts would not reach their full potential and would possibly fail unless a new light was turned on the values at the core of medicine. Where has medicine been, where ought it to be going, and what should its future priorities be? These are important and difficult questions. An international group worked on them for four years, and this report is the result of its efforts.
The social and medical ethos within which bioethics emerged in the late 1960s and early 1970s was constituted in part by religious questions and religious thinkers. However, this identifiably religious influence on bioethics subsequently seemed to decline. How has this diminished impact come about, and what significance, if any, does it hold for the ways we now do bioethics? What difference, finally, do religious perspectives make for bioethics? These were the overarching questions that led The Hastings Center to initiate a research project on the relation of religion and bioethics, culminating in this special supplement.
This report provides a sampling of the many innovative ethics programs being explored on campuses at the time and offers an analysis of the critical debate that surrounded them. It also looks at strategies for teaching, ways of organizing ethics education programs, and recommendations for developing program agendas. It is the result of a project on values education.
The six key public policy recommendations contained in this report are the outcome of a two-year research project, Care for the Elderly: Goals and Priorities, organized jointly by The Institute for Bioethics in Maastricht, the Netherlands, and The Hastings Center. The purpose of the project was to focus attention on the moral problems of care for the elderly—in particular, to the obligations owed to the elderly by individuals and society, the reciprocal obligations on the part of the elderly, and the ethical dilemmas that sensitive care for them cannot avoid. Most generally, participants wanted to call attention to the often hidden value issues and considerations of a discussion that in most countries is restricted to economic and institutional arrangements only.
In 2005, the world was rivited by Theresa Schiavo, who lay in a persistant vegetative state, kept alive by a feeding tube. Her husband sought to have her feeding tube removed to fulfill what he believed were her wishes, but her parents fought to keep her alive. Four commentators discuss what made the case so difficult, why it was more complex than most people realized, and what should have been done differently.
When it was signed into law in 2006, Massachusetts health care reform was the most ambitious effort in many years to change the U.S. health insurance system. In this collection of essays, published shortly after the law was passed, a health economist who advised the state on reform describes the plan and how it unfolded. Five commentaries weigh its odds of success and ask whether it can provide a model for the nation.
Reproductive technologies, sometimes dubbed "reprogenetics" because they stand at the intersection of assisted reproduction and genetics, can both help people have children and give them greater choice over the kind of children they have. In the lead essay of this set, Franco Furger and Francis Fukuama argue that reprogenetics should be regulated and that regulation requires tactics that have no precedent in the United States. Four other essays offer contrasting views of various aspects of the proposal.
The clinical research landscape is changing rapidly, and the system for overseeing research has failed to keep pace. The mechanisms for protecting human subjects may be too stringent in some places, too weak in others, and overtaxed and unreliable overall. These essays survey the trouble spots and point the way to effective reform.
Fewer than half of medical interventions are supported by scientific evidence. These essays examine the hopes that the recent push for comparative effectiveness research will improve medical care, the fears that it could harm the doctor-patient relationship, and the experiences of states and countries that already put it into practice.
Marking the fortieth anniversary of The Hastings Center, these essays examine the four core issues that the Center originally identified as its domain. Cofounder Daniel Callahan takes up population control. Cofounder Willard Gaylin recalls behavior control efforts, which arose alongside early discoveries about the brain-behavior link. Other essays discuss foundational work at Hastings on ethical issues in death and dying and in human genetics.
More children than ever are undergoing medical interventions for nonmedical reasons. As parents consent to an increasing variety of procedures, the ethical and legal debate grows louder. These essays visit the frontiers, asking what justifies changing a child's physical nature and whether appeals to nature should influence decision-making.
Cheating evolves constantly. Many athletes have been banned from the Olympics and other major events for taking banned substances. Gene doping is on the horizon. Questions have arisen about which athletes count as "female." What does it take to keep sports fair? And what does fairness require?
This report, which grew out of The Hastings Center project on bioethics education, focuses on a neglected problem: the education of medical professionals and laypeople who want something more than a cursory introduction to bioethics, but something less than an advanced degree. It sets out core theoretical content for a grounding in bioethics, looks at how to translate theory into action, gives strategies to evaluate bioethics programs, explores issues of certification, and considers both the contexts in which the teaching and learning of bioethics may occur and the personal beliefs and different types of training that can feed volatile debates of controversial ethical issues. The report includes a bibliography and a then-current listing of graduate programs in bioethics.
When it was undertaken, the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) was the most comprehensive, ethically significant, and puzzling investigation of death in American hospitals to date. SUPPORT was designed to increase understanding of hospitalized dying and to devise an intervention to promote more humane care by improving communication, clarifying and coordinating preferences, and controlling pain—worthy goals, but the intervention failed. In no area did it achieve any improvement that was substantial or unambiguous. As a result, the study’s funding agency, the Robert Wood Johnson Foundation, asked The Hastings Center to commission a series of papers exploring its conclusions. The essays making up this special supplement aim to acquaint readers with SUPPORT’s findings, to make sense of them, and to probe possible responses.
The authors of this special supplement—Jeremy Sugarman, Douglas C. McCrory, Donald Powell, Alex Krasny, Betsy Adams, Eric Ball, and Cynthia Cassell—conducted a systematic retrieval of published empirical research on informed consent as part of an effort to ensure that patients and research subjects within the Veterans Affairs health care system give meaningful informed consent. The research compiled—377 articles in all, incorporating 3,173 specific hypotheses—is cited in alphabetical order with a brief description of content. This supplement is an invaluable guide to literature on informed consent in the twentieth century.
To reproduce or not to reproduce, to screen genetically or not to screen, to abort or not to abort? The ethical answers to these questions seem significantly determined by where the questions are asked. This second special supplement on international bioethics contains essays, conference reports, a case study, and bibliographies. Among other topics, it explores physicians’ moral obligations when confronted by systematic, politically motivated torture in South Africa and Uruguay, ethical consensus in the face of cultural pluralism in Scandinavia, and markedly differing attitudes toward death and dying among both patients and health care providers in Greece, Colombia, and Uruguay.
This third special supplement on international bioethics contains a collection of essays and bibliographies that attempts to encourage a comparative bioethics. It explores how a Western, “universal,” and innovative scientific medicine confronts traditional, culture-bound values in developed and developing nations alike. The countries represented include Turkey, Ghana, New Zealand, Kuwait, Germany, Malta, and the United Kingdom. Topics include health care allocation, rationing, elder and end-of-life care, and an international look at mapping the human genome and ethics in genetics.
What could we do, and what should we do, to make organs more available? This twenty-page introduction to the topic explores the possibilities. A diverse assortment of policy options has emerged for promoting organ donation, leading to intense debate about the merits and drawbacks of each. Some proposed strategies would use financial or other incentives to promote organ donation, some take advantage of the Internet’s unique capacity to disseminate information and put strangers in touch with each other, and some preserve and refine the traditional donation approach. These strategies will not be equally effective, however, and some that might be effective might not be ethically appropriate.
On May 18, 1995, nearly two hundred religious leaders joined with biotechnology critic Jeremy Rifkin in a press conference named the “Joint Appeal against Human and Animal Patenting,” a move that many within the biotechnology industry could only interpret as seeking to inhibit biotechnological advances. What moral and religious concerns motivated this challenge to patenting? How could the biotechnology industry understand and respectfully attend to these concerns? What values were at play in the debates that followed the joint appeal? What lessons for future dialogue can be learned from attempts at conversation between the opposing positions? This supplement—the report of a Hastings Center research project of the Values and Biotechnology Program—addresses these questions.
Increasingly, homes are becoming more like hospitals. There, more and more patients receive highly sophisticated medical treatments that twenty years prior to this report would have been available only in special care units. Much of the time, this high-tech care is dispensed not by physicians or other specially trained professionals, but by the patients themselves when capable, or by their parents, spouses, adult children, and partners—that is, by ordinary people with no special medical training. In the midst of this, important questions bearing on access, equity, standards of quality, and the consequences of such care for patients and their families go largely unaddressed. This supplement presents abridged versions of five major papers in the book Bringing the Hospital Home: Ethical and Social Implications of High-Tech Home Care (Johns Hopkins, 1995), edited by John Arras.
This is the only issue of the Hastings Center Report ever given over to the impact of a single philosophical and ethical thinker. Hans Jonas—philosopher émigré from Hitler’s Germany, solider in the British Underground during World War II, and after the war an artillery officer in the Israeli Army—was a major force at The Hastings Center from its early work on the definition of death and human subjects research until his death in 1993 at the age of nearly ninety. The essays in this issue—by Leon Kass, Strachan Donnelley, and Lawrence Vogel, among others—reflect the living legacy and abiding importance of Hans Jonas’s work. They focus on crucial and unresolved issues about the nature and significance or organic, animal, and human life, the nature of human responsibility and our fundamental ethical obligations, and the practical role of the philosopher and ethicist in the public realm.
